QA/ Process Specialist - RCM

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
Job Description Summary
As an RCM QA/ Process Specialist, you will be responsible for team handling, audits, work allocation, client interactions and generate distribute RCM metrics reports to the leadership team.
Excellent communication skills, attention to detail, and strong technical and problem-solving skills are essential aspects of this role.
Job Description
• Thorough understanding of RCM processes like Billing, Cash Posting, Credit Balance, Accounts Receivables, Denial Management & Correspondence review
• Very good understanding of RCM metrics like Days in AR, Ageing above 90 days, Collections and bad debt
• Perform Quality checks/audits on all claims processed as per quality policy or as per client SOP
• Responsible for getting the claims processed in compliance to the billing rules mentioned and ensure all errors are identified in QA and actions initiated before the claim is rebilled to the insurance
• Implement Lean Six sigma mythologies to improve the accuracy of the processes
• Consistently review the audit parameters and modify as per the necessary requirement
• Prepare daily, weekly & monthly audit metrics reports and share it with leadership
• Conduct analysis and present summary of findings to leadership in a clear, concise, convincing and actionable format
• Establish a strong relationship with Team Leaders / Managers by demonstrating the gaps, trends & patterns identified during the data/report compilation
• Suggest ways of improvements and set up calibration sessions with onshore and internal teams
• Develops documentation of quality related MIS work to have smooth operations and easy system maintenance
QUALIFICATIONS:
• 3+ years of industry experience
• 2+ year Experience in relevant RCM functions performing quality audits
• Hands on experience in reporting with proficiency in MS Excel and MS PowerPoint
• Strong ability to analyze raw data, draw conclusions and develop actionable recommendations
• Ability to handle multiple tasks of reporting simultaneously
• Ability to adapt quickly to new and changing technical environments as well as strong analytical, problem solving and quantitative abilities.
Solid verbal and written communication skills are required.
Education/Certifications:
• Graduate
• Any quality related certifications like Lean Six Sigma can be an added advantage
Education/Certifications:
• Graduate in any discipline.
ABOUT HURON:
At Huron, we’re redefining what a consulting organization can be. We go beyond advice to deliver results that last. We inherit our client’s challenges as if they were our own. We help them transform for the future. We advocate. We make a difference. And we intelligently, passionately, relentlessly do great work…together.
Are you the kind of person who stands ready to jump in, roll up your sleeves and transform ideas into action? Then come discover Huron.
Whether you have years of experience or come right out of college, we invite you to explore our many opportunities. Find out how you can use your talents and develop your skills to make an impact immediately. Learn about how our culture and values provide you with the kind of environment that invites new ideas and innovation. Come see how we collaborate with each other in a culture of learning, coaching, diversity and inclusion. And hear about our unwavering commitment to make a difference in partnership with our clients, shareholders, communities and colleagues.
Huron Consulting Group offers a competitive compensation and benefits package including medical, dental, and vision coverage to employees and dependents; a 401(k) plan with a generous employer match; an employee stock purchase plan; a generous Paid Time Off policy; and paid parental leave and adoption assistance. Our Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops, as well as ongoing programs recognizing major events in the lives of our employees throughout the year. All benefits and programs are subject to applicable eligibility requirements.
The Company is fully committed to providing equal employment opportunity in recruitment, employment, compensation, benefits, promotions, transfers, education, and all other terms of employment. Huron will not discriminate on the basis of age, race, color, gender, marital status, sexual orientation, gender identity, national origin, religion, Vietnam era of veteran status, physical or mental disability, creed, citizen status or any other status protected by federal, state of local law. We endeavor to maintain a drug-free workplace.
Position LevelAssociate
CountryIndia